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APPENDIX – I
PROFILES OF THE SELECTED HOSPITALS
1. APOLLO HOSPITALS ENTERPRISE LIMITED
Hospital Overview
Apollo Hospitals Enterprise Limited (AHEL) a part of Apollo Hospitals
Group, is a private sector healthcare provider. The company owns and
manages a network of specialty hospitals and clinics and a chain of pharmacy
retail outlets. It also provides consultancy services for commissioning and
managing the specialty hospitals. The company operates primarily in India. It
is headquartered in Chennai, India.
The company recorded revenues of INR 9,566 million (approximately
$212 million) during the fiscal year ended March 2007, an increase of 24.4%
over 2006. The operating profit of the company was INR 1,495 million
(approximately $33.1 million) during fiscal year 2007, an increase of 63% over
2006. The net profit was INR 954 million (approximately $21.1 million) in fiscal
year 2007, an increase of 83.5% over 2006.
Business Description
Apollo Hospitals Enterprise (AHEL) is the private sector healthcare
provider in Asia. AHEL operates through two business divisions: chain of
owned and managed hospitals and management consultancy services.
Through the chain of owned and managed hospitals division, the group
operates over 26 hospitals of which 14 are client hospitals, managed by
professionals deputed from Apollo Hospitals group.
The group’s consultancy division provides management consultancy
services. The division offers project and operations management consultancy
services to clients varying from conceptualization to commissioning of a range
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of healthcare models. The group is also engaged in providing hospital care
and healthcare delivery services. It provides nursing and hospital
management colleges, pharmacies, diagnostic clinics, medical transcription
services, third-party administration and telemedicine.
AHEL provides healthcare services and programs including, health
checkup, complementary and alternative medicine, corporate health
programmes, Apollo life magazine, disease management, understanding
medical investigations and Apollo clinics. Apollo Hospitals operates hospitals
in Chennai, Delhi, Hyderabad, Kolkata, Ahmedabad, Bangalore, Bilaspur,
Madurai, Visakhapatnam and Kakinada. AHEL has international operations in
Srilanka, Muscat, Dubai, India, Nepal, Tanzania, and Bangladesh.
History
Apollo Hospitals Enterprise Limited was incorporated as a public
limited company in 1979. The group negotiated with British American
Investment for association in a joint venture for setting up a multi-specialty
hospital on a state land provided by Government of Mauritius, in August 2007.
Major Products & Services
Apollo Hospitals is an Indian-based healthcare company. The
company’s key services include Chain of owned and managed hospitals and
Management consultancy services.
Apollo Hospitals is a leading player in the high-growth healthcare
sector. It currently has a network of 18 owned hospitals and 8 hospitals
through subsidiaries / JV / associates totaling to more than 4,000 beds. The
company also has 12 hospitals under management contracts which increases
its spread and raises its total bed count to more than 6,800. Apollo has
presence across the healthcare delivery value chain with 420 pharmacy
outlets. Its integrated business model, scale, national footprint and presence
across multiple disease and delivery segments make it one of the best plays
on the sector.
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Hospital Background
Apollo Hospitals Enterprises Ltd (AHEL) was incorporated as a public
limited company in 1979. Promoted by Dr Prathap C Reddy, it is the first
group of hospitals that pioneered the concept of corporate healthcare delivery
in India. AHEL today is the leading private sector healthcare provider in Asia
and owns and manages a network of specialty hospitals and clinics, a chain of
pharmacy retail outlets across the country, and provides consultancy services
for commissioning and managing hospitals. With nursing and hospital
management colleges, pharmacies, diagnostic clinics, medical transcription
services, third-party administration and telemedicine, Apollo's leadership
extends to all aspects of the healthcare spectrum.
The consultancy division of AHEL offers project and operations
management consultancy services to clients varying from to commissioning of
a wide range of healthcare models. Over the years, Apollo Hospitals has
founded various group companies to empower its flagship company, Apollo
Hospitals Enterprise Ltd, to create a healthcare powerhouse that has a
leadership position in every sphere of healthcare.
Medical Specialties offered
Apollo has established centers of excellence in a variety of medical
disciplines – cardiology, oncology, orthopaedics, cosmetic and plastic surgery,
critical care medicine and emergency and trauma care through their multi-
specialty and super-specialty tertiary care hospitals which offer highly
specialized and sophisticated medical care and surgical procedures in a
primarily inpatient setting. CRIS-INFAC estimates that expenditure on tertiary
care hospitals comprised approximately 15-20% of the total Rs 125,300 crore
spending for healthcare delivery in India in 2006.
According to CRIS-INFAC, this segment is expected to grow faster
than the primary or secondary care segments because of an expected rise in
complex lifestyles. Apollo hospitals have around 3800 super-specialty and
multi-specialty beds owned by self or subsidiary/associate/ JV, which are
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spread in metros, tier-I and tier-II cities, stand to gain the most with the
expected increased demand in healthcare delivery market in India.
2. CARE HOSPITAL
Care Hospitals is one of the fastest growing chains of hospitals in India,
engaged in providing primary as well as tertiary healthcare services, with a
difference. It is a hospital chain that is founded and managed by professionals
with a mission and a passion for providing healthcare for the needy. At CARE,
the growth has been phenomenal. From a 100-bed single specialty Heart
Institute facility focusing on cardiac care in Nampally (Hyderabad), CARE has
become a multi-specialty hospital chain comprising of 1400 beds across 12
hospitals.
Care’s reputation for its humanitarian and selfless service has ranked
this esteemed institution as the fourth largest healthcare provider in India
(CRIS-INFAC report, 2006). The effort to provide quality health care with
compassion has rewarded with the honor of being the top healthcare provider
in Andhra Pradesh. With the service-oriented Healthcare delivery model,
CARE is geared to provide cost effective and user friendly medication.
Despite the intense competition and intense marketing tactics employed by
multiple commercial corporate organizations, CARE has carved a niche for
itself by garnering the best reputation amongst the local masses. Armed with
the best of the facilities in areas of Education, Research, patient care and
highly qualified professionals, CARE endeavors to match global benchmarks
and conquer healthcare market in the second decade of its establishment.
CARE aims at providing a holistic approach to healthcare. The logo
has been crafted with this thought in mind. Through the explanation of the
logo and identity, endeavor to help partners, branch organizations,
shareholders and esteemed patients understand CARE and its entity better.
Brand Identity and Name are largely dependent on the Logo. People identify
an organization with its Logo. It is a Logo that states in part the organizations
ethics and values.
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History
A movement called ‘CARE’ took birth in the year 1997, when
Padmashri
Dr. B. Soma Raju led a team of medical professionals to set up the first CARE
Hospital. It opened a new chapter in the history of health care. The driving
force of Compassion, Concern, Care, coupled with single minded objective -
the recovery of the patient is been the fountainhead of inspiration. Today,
within a span of 13 years, CARE has emerged as the leading name in health
care and has earned a reputation for humanitarian and self less service. But,
most importantly, CARE has the undivided faith of millions.
The origins of CARE can be traced to 1983 when a team of
cardiologists, under the leadership of Padmashri Dr. B Soma Raju, set up a
synergy for professional excellence in the cardiology department of the
Nizam’s Institute of Medical Sciences (NIMS) in Hyderabad. The idea was to
propel the cardiology department into one of the top centers in the country.
The synergy gave momentum to the purpose and accelerated the birth of
CARE 13 years later. The team collaborated with scientists to make
healthcare affordable through the development of indigenous medical
technologies. It was the development of India’s first coronary stent (Kalam-
Raju stent) that inspired the creation of CARE Hospital in 1997 to nurture a
model that makes quality medical care affordable and accessible.
• At the outset, CARE earned accolades and appreciation from one and
all for its expertise in heart care. It continues to set new benchmarks
not only in heart care, but also expanded its horizons by becoming a
leading Multi-specialty Health Care Provider.
Accreditations
The following shows the accreditations CARE has enjoyed from reputable
sources.
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• CARE laboratories at CARE (Banjara) enjoy the accreditation from the
National Accreditation Board for Testing and Calibration Laboratories
and are awaiting inspection for ISO certification.
• CARE Foundation’s courses are accredited by National Accreditation
Boards like the Indira Gandhi National Open University (IGNOU), Netaji
Subhash Open University (NSOU), and the National Board of
Examination.
• A Physician Assistants (PA) program that commenced in 2003
received an accreditation from the NSOU
Management
Governance & Leadership
Every organization or Group’s growth and prosperity is largely
dependent on the leadership of the organization. It is an indisputable
fact that CARE Group of Hospitals has grown in reputation and profits
primarily because of the governance and leadership. Care’s
governance and leadership team has been undoubtedly responsible for
the growth of CARE as a Hospital Group. The following are the team of
people responsible for CARE governance and leadership:
Operations
CARE has accomplished growth in many facets but it’s the growth in
the number of patients that stands testimony to widening network of
operations. The trust the people have placed has further motivated in
furthering contribution to the patient care.
� 18% growth in OP registration to 31523 lakh in 2005-06
� 11% growth in IP admissions to 3486 lakh in 2005-06
� 11.09% increase in the number of surgeries performed in 2005-06.
� A 500 basis point increase in the average occupancy to about 70% in
2005-06.
� Specialists’ number increased from 20 to 100.
� Clinical and procedural outcomes on par with US Norms.
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� Control the cost components of patient care such as drugs disposables
and consumables account for nearly 50% of the total expenses, the
highest cost element in a hospital – to provide a superior value to
patients.
� Providing qualitative medical care has resulted in increase in patients
preferring CARE. This fact is reflected in the consistent growth in the
bypass surgeries, growing at a CAGR of 30% over the last nine year
3. NIZAM’S INSTITUTE OF MEDICAL SCIENCES
About NIMS
Nizam’s Institute of Medical Science was established (NIMS) in 1964
and has grown into a University in Hyderabad A.P. India and is one of the
pioneer and major referral medical center with about 100 beds with staff
around 2000. In 2005 bed occupancy rate was 83%, total admissions 30,481,
total hospital days 2,88,002, total operations are 18, 111 and average length
of stay 9.5 days.
NIZAM’S INSTITUTE OF MEDICAL SCIENCES (NIMS), Hyderabad, is
a University established under the Act of Andhra Pradesh State Legislature.
Inspired by the objectives, the Medical and Management professionals
of NIMS are striving for excellence. As part of it, several courses have been
organized under different disciplines. NIMS is recognized by University Grants
Commission and Medical Council of India.
The administration of NIMS is carried out under the supervision of
Governing Council, Executive Board, Director and other statutory bodies.
NIMS is located at the prime centre of the twin cities of Hyderabad and
Secunderabad, and spread over an area of about 23 acres. It has the
constructed area of more than six lakh sq.ft. The recently constructed giant
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structure, i.e., Millennium Block, itself has added an area of about one sixth of
the total space. This Institute extends its services through 28 Departments.
Out of them, 16 are super and Broad Specialties and others are Supporting
Departments.
The Institute has bed strength of 985 beds, out of which 684 are in
General Wards, 117 in private rooms and 184 in emergency and post
operative care. The average number of out-patients visiting the hospital per
day is about 1275, and the number of in-patients admitted per day is about
80. The average bed occupancy is over 89%.
Subsequently this University has raised to a cadre strength of about
2219 staff members, which includes Faculty-139, Residents (students)-172,
Junior and Senior Residents-43, Medical Officers & Senior Medical Officers-
14, College of Nursing & School of Nursing-6, College of Physiotheraphy-6,
Offcers-14, Ministerial-149, Paramedical-304, Nursing-426, Class IV-115,
Consolidated Staff-21, other workers about 810 and the remaining for other
categories. Interestingly NIMS has been consistently maintaining a very good
patient doctor ratio of about 3:1.
The Origin of NIMS
The Genesis of NIMS dates back to the year 1961. The Nizam's
Charitable Trust thought of starting a specialty Hospital for orthopedic patients
with an initial investment of Rs.55 Lakhs. The foundation stone was laid on
16.07.1961 by Sri Morarji Desai, Minister for Finance, in the cabinet of Sri
Jawaharlal Nehru, the first Prime Minister of India.
As per the Act, NIMS has a Governing Council as its supreme
authority. The Chief Minister of Andhra Pradesh is the President and the
Health Minister, the Vice President. This helps to have close contacts with the
authorities in developing NIMS. For a close supervision of the activities
during shorter spells, NIMS has an Executive Board with seven members
presided by Health Minister of Andhra Pradesh. In addition NIMS has an
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Academic Council with strength of 35 members for advising and approving the
Academic Programmes of this Institute.
Departments
Clinical Departments
1. Anaesthesiology and Intensive Care
2. Cardiology
3. Cardio Thoracic Surgery
4. Clinical Pharmacology & Therapeutics
5. Chest Clinic
6. Dental
7. Dermatology
8. Endocrinology and Metabolism
9. Gastroenterology
10. General Medicine
11. Gynaecology
12. Medical Oncology
13. Nephrology
14. Neurology
15. Neuro Surgery
16. Orthopaedics
17. Paediatrics
18. Physio Therapy
19. Plastic Surgery
20. Radiation Oncology
21. Rheumatology
22. Surgical Gastroenterology
23. Surgical Oncology
24. Urology
25. Vascular Surgery
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Diagnostic Departments
1. Biochemistry
2. Microbiology
3. Nuclear Medicine
4. Pathology
5. Radiology & Imageology
6. Transfusion Medicine
Supporting Departments
1. Biomedical Engineering
2. Civil
3. Computer Division
4. Electrical
5. Hospital Administration
6. Medical Records
7. College of Nursing
Other Departments
In an addition to the above, departments the Gas Room, Stores
(Medical, Surgical, Stationary, Linen) extend their services for
Maintenance of the Institute.
Academic Courses
On the Academic front the Institute conducts several courses
recognized by Medical Council of India. It offers about 40 disciplines. NIMS
conducts 8 super specialty courses in DM and M.Ch. in the Departments like
Cardiology, Cardiothoracic Surgery, Neurology, Neurosurgery, Nephrology,
Plastic Surgery, Urology and CP&T.
Similarly NIMS conducts 6 broad specialty courses of MD, MS and
DMRD in the Departments like General Medicine, Pathology, Orthopaedics,
Anesthesiology, Radiology and Hospital Administration. College of Nursing
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started on 2nd October 1991 and 209 students have completed B.Sc
(Nursing) till 2004. This is recognized by Indian Nursing Council.
Hospital Services
The performance of the Institute as a hospital is measured with the
parameters of number of beds, number of Out-patients, number of In-
patients, number of Surgeries, bed occupancy rate, average length of stay,
mortality rate and revenue generation.
Presently the hospital has 985 beds compared to 246 beds of 1986.
Out of these 985 beds, 684 are in general wards, 117 in private rooms and
184 in emergency and post operative care. The average number of out
patients visiting the hospital per month is about 32,000 and the number of in-
patients admitted per month is about 2,600.
It is gratifying to note that NIMS is a referral Hospital with a clientele of
more than 250 organizations. During the year 2008, the number of out-
patients has recorded a figure of 4.12 lakhs, which may be compared with
1.09 lakhs in 1986. Similarly the number of in-patients has increased from
about 6,758 to 31,295 during the same period. Presently the average bed
occupancy is about 89%.
While the average length of stay is 11 days during the year 2008, the
mortality rate is about 2% leaving the well being at 98%. Interestingly NIMS is
consistently maintaining a very good ratio of about 3:1 for the patient to the
Doctors. All these figures under different heads speak out ultimately the
services rendered by NIMS to the patients, quantitatively.
The number of surgeries is almost maintained at about 27,767 in the
year 2008. Out of them 8,701 are major operations, 16,248 are minor
operations and 2,818 are emergency operations.
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5. GANDHI HOSPITAL
History
Gandhi Medical College came into operations on 14th September 1954
AD. This was the second medical college in the erstwhile state of Hyderabad.
The Osmania Medical College was the first medical college in the Hyderabad
state having started as a medical school in 1846 and made a college in 1926.
Gandhi Medical College was the second in Hyderabad State, fourth in
Andhra Pradesh and 29th in the country. Average annual outpatient
consultations are about 80000 and there were about 42000 inpatient
admissions.11000 major operations and about 15000 minor operations are
performed each year at Gandhi hospital. Hospital has 27 departments
namely: general medicine, general surgery, pediatrics, orthopedics,
anesthesia, dermatology, leprosy, sexually transmitted disease,
ophthalmology, E.N.T., radiology, Casuality, blood bank, cardiology,
neurology, nephrology, gastroenterology, endocrinology, Cardio-thoracic
surgery, neurosurgery, pediatric surgery, plastic surgery, urology, TB clinic,
dental, obgyn, psychiatry and hospital administration.
During the 50 years i.e. 1954-2003 a total of 6090 students were
admitted to the MBBS course. The number of students admitted ranged
between a minimum of 42 in 1954 to a maximum of 224 in 1968. In one-year
i.e. 1970 there were no admissions. In recent years the admissions are
around 150 per year. There are some students who may have been
transferred from other medical colleges to Gandhi and very few left medical
studies to pursue other avenues in life.
As of now, the Rs 100-crore, 1600-bed Gandhi Hospital and Medical
College buildings complex, located in a 30-acre site, was created in a record
time. The 152-year-old hospital has about a million sq ft of built-up space,
hosting some 29 specialties. This hospital was created in 1851 to look after
the British residents of Secunderabad hosting a general, maternity and a ward
for paupers.
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The hospital project was executed by the Andhra Pradesh Health and
Medical Housing and Infrastructure Development Corporation. The Gandhi
Hospital lacks proper equipment in many departments, including neurology,
nephrology, cardiology and gastroenterology as most of them need
replacement and are out-dated. As a result, patients coming for routine check-
ups have to be referred to other hospitals.
Moreover, the hospital that has 1,012 beds and caters to over 900 out-
patients daily, has not more than Rs 30 lakh in the Hospital Development
Society Funds for replacement of equipment and has to depend on
government support that is not forthcoming.
The cardiology, neurology, nephrology and gastroenterology
departments are the wings that need urgent replacement of equipment.
However, the heads of department (HOD) have requested the government to
sanction Rs 40 crore to buy new machinery.
According to doctors at the hospital, though many patients come for
simple tests and scans, they have to be referred private hospitals where
charges are higher and to other better equipped government hospitals like
Osmania General Hospital due to lack of equipment.
The hospital also needs dialysis machines, as most of the machines
are very old. Even ventilators also need to be replaced. Moreover, the hospital
does not have a CT scan machine that is essential for investigations in most
departments. Among the list that has been forwarded by the hospital
management for replacement are half-a-dozen ventilators, 16 fully equipped
surgical operation theatres, six dialysis machines and video endoscopes and
a CT scan machine.
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6. OSMANIA GENERAL HOSPITAL
Osmania General Hospital is a multi specialty quaternary care hospital
with advanced training in every sub-specialty of Medicine, Surgery, Radiology,
Anesthesiology, Orthopedic surgery, Neurosurgery, Neurology. This hospital
has approximately 3800 beds, with patients overfilling the beds and wards. It
has one of the busiest Out-Patient clinics in all specialties in India, particularly
on Monday mornings.
By the end of the year 2008, Osmania General Hospital has become a
multi-specialty quaternary care hospital in Hyderabad, offering 3800 beds with
all necessary facilities & amenities. It has one of the busiest Out-Patient
clinics in all specialties in India.
Osmania Medical College is a medical school in Hyderabad, Andhra
Pradesh, India. It was founded in 1846 as the Hyderabad Medical School
making it one of the oldest medical schools in the world. It is presently
affiliated to the NTR University of Health Sciences. The College was originally
affiliated to the Osmania University of Hyderabad.
The Main Undergraduate course offered at the School is an MBBS
(Bachelor of Medicine, Bachelor of Surgery) course. In addition the college
also offers other undergraduate courses and many Postgraduate (graduate)
courses. It also offers many Super specialty courses.
The College campus is situated in Koti, which is at the heart of the city
of Hyderabad. Osmania Medical College has long been a government
institution in Andhra Pradesh. It is the oldest medical school in India and
perhaps Asia. Osmania has a rich history of pioneering medical innovations.
For the first time, chloroform was used as an anesthetic in Osmania. The
causative agent of malaria was elucidated by Sir Ronald Ross who has been
immortalized by the Sir Ronald Ross Institute of Tropical and Communicable
Diseases (popular by name Fever Hospital) affiliated to Osmania.
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OGH is the only medical college in India (and perhaps the world),
where each medical specialty has a separate training hospital. It is also the
only medical college in south India to offer a postgraduate course in
endocrinology.
Conclusion on Profiles of Hospitals
All these five hospitals though vary in the intensity of level of
implementation, varies in usage of management techniques in bringing the
quality for patient satisfaction or the implementation of quality initiatives but
comparably comes close in the efforts to strive towards providing better
healthcare deliverables to patients.
There are few areas present in all most all these 5 hospitals which
show significant efforts to avoid patient injury occurring in hospitals, reduce
the risk of adverse outcomes and lower costs. They all know that poor health
service quality wastes resources that could be used to treat more patients,
and the public is becoming more critical of the quality of hospital care. Most of
them quite aware that ensuring safety for patients and personnel and
improving quality are national objectives for health systems in both developed
and developing countries, in response to research highlighting poor quality,
increasing patient expectations, media coverage, and a belief that there are
effective methods to improve quality and safety. Further, it is an open thought
that health care organizations are increasingly expected by governments and
funders to introduce quality systems and strategies. Some health care
managers and practitioners also believe that action can and should be taken,
irrespective of external pressures.
While having a discussion with the administrators, doctors etc of these
five hospitals during collection of completed survey, it is interested to note that
some of them shared their thoughts which include proposal of multiple
approaches to ensuring safety and improving quality. Some think money
should be invested in more personnel; others think that doing more of the
same would not improve quality. Which strategies are most appropriate and
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cost effective for a particular hospital in a specific situation? Which approach
should a government promote?
This may not be a complete review of available research on multiple
quality topics but an attempt in synthesizing many types of research into
hospital quality strategies. The aim of this study is to come out of few
constructive thoughts enabling the decision makers to better formulate,
implement and evaluate strategies. Research puts competing claims made by
proponents of each approach into perspective and can help avoid costly
mistakes from choosing the wrong strategy or implementing it incorrectly.
There is no strong scientific evidence of which strategies are effective. It is
difficult to make valid comparisons among strategies. But there is useful
research that gives partial assessments of results, describing different types
of strategy, and suggesting means of implementation.
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APPENDIX – II
QUESTIONNAIRES USED FOR THE STUDY
1. QUESTIONNAIRE – FOR PATIENTS This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.
This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a mark that best shows your expectations about firms offering health services.
1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually
appealing. 1 2 3 4 5 6 7
3. The staff (doctors, nurses etc) is well dressed and appears neat.
1 2 3 4 5 6 7
4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required.
1 2 3 4 5 6 7
5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.
1 2 3 4 5 6 7
6. When you have problems, the staff (doctors, nurses etc) was sympathetic and reassuring.
1 2 3 4 5 6 7
7. The hospital is dependable 1 2 3 4 5 6 7 8. They have provided their services at the time they
promised to do so 1 2 3 4 5 6 7
9. They have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when
services will be performed 1 2 3 4 5 6 7
11. You did not receive prompt service from the hospital staff (doctors, nurses etc)
1 2 3 4 5 6 7
12. Staff (doctors, nurses etc) of the hospital not always willing to help patients
1 2 3 4 5 6 7
13. Staff (doctors, nurses etc) of the hospital are too busy to respond to patient request promptly
1 2 3 4 5 6 7
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14. You can trust the staff (doctors, nurses etc) of the hospital.
1 2 3 4 5 6 7
15. You feel safe in their transactions with the hospital staff (doctors, nurses etc).
1 2 3 4 5 6 7
16. The staff (doctors, nurses etc) of the hospital is always polite.
1 2 3 4 5 6 7
17. The staff (doctors, nurses etc) get adequate support from the hospital to do their jobs well
1 2 3 4 5 6 7
18. The hospital did not give you individual attention 1 2 3 4 5 6 7 19. Staff (doctors, nurses etc) of the hospital did not
give you personal attention 1 2 3 4 5 6 7
20. Staff (doctors, nurses etc) of the hospital do not know what your needs are
1 2 3 4 5 6 7
21. The hospital did not have your interests at heart 1 2 3 4 5 6 7 22. The hospital did not have operating hours
convenient to all their patients 1 2 3 4 5 6 7
Personal Information Gender :
Male Female
Age (Years) :
Below 30 30-60 Above 60
Income per annum (Rs) :
Below 1 Lakh
1 – 3 Lakhs
Above 3 Lakhs
Residing in:
Urban Rural
Education:
Illiterate School College
No. of visits:
First time Second time
More times
Category of treatment:
ICU Surgical Medical
I sincerely thank you for spending your valuable ti me and kindly return the filled-in form to the investigator who handed o ver this to you.
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2. QUESTIONNAIRE – FOR ADMINISTRATORS
This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.
This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually
appealing. 1 2 3 4 5 6 7
3. The administrative staff is well dressed and appears neat.
1 2 3 4 5 6 7
4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required.
1 2 3 4 5 6 7
5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.
1 2 3 4 5 6 7
6. When patients have problems, the administrative staff is sympathetic and reassuring.
1 2 3 4 5 6 7
7. The hospital is dependable 1 2 3 4 5 6 7 8. You have provided services at the time you
promised to do so 1 2 3 4 5 6 7
9. You have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when
services will be performed 1 2 3 4 5 6 7
11. Patients did not receive prompt service from the administrative staff
1 2 3 4 5 6 7
12. Administrative staff of the hospital not always willing to help patients
1 2 3 4 5 6 7
13. Administrative staff of the hospital are too busy to respond to patient request promptly
1 2 3 4 5 6 7
14. Patients can trust the administrative staff of the hospital.
1 2 3 4 5 6 7
15. Patients feel safe in their transactions with the Administrative staff.
1 2 3 4 5 6 7
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16. The administrative staff of the hospital is always polite.
1 2 3 4 5 6 7
17. The administrative staff get adequate support from the hospital to do their jobs well
1 2 3 4 5 6 7
18. The hospital did not give individual attention to patients
1 2 3 4 5 6 7
19. Administrative staff of the hospital did not give personal attention to patients
1 2 3 4 5 6 7
20. Administrative staff of the hospital do not know what patients needs are
1 2 3 4 5 6 7
21. The hospital did not have patients interests at heart
1 2 3 4 5 6 7
22. The hospital did not have operating hours convenient to all their patients
1 2 3 4 5 6 7
I sincerely thank you for spending your valuable ti me and kindly return
the filled-in form to the investigator
xxi
3. QUESTIONNAIRE – FOR DOCTORS This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.
This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually
appealing. 1 2 3 4 5 6 7
3. The doctors are well dressed and appear neat. 1 2 3 4 5 6 7 4. The appearance of the physical facilities of the
hospital is excellent, keeping in view of the type of services required.
1 2 3 4 5 6 7
5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.
1 2 3 4 5 6 7
6. When patients have problems, the doctors were sympathetic and reassuring.
1 2 3 4 5 6 7
7. The hospital is dependable 1 2 3 4 5 6 7 8. You have provided services at the time you
promised to do so 1 2 3 4 5 6 7
9. You have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when
services will be performed 1 2 3 4 5 6 7
11. Patients did not receive prompt service from the doctors
1 2 3 4 5 6 7
12. Doctors of the hospital not always willing to help patients
1 2 3 4 5 6 7
13. Doctors of the hospital are too busy to respond to patient request promptly
1 2 3 4 5 6 7
14. Patients can trust the doctors of the hospital. 1 2 3 4 5 6 7 15. Patients feel safe in their transactions with the
doctors. 1 2 3 4 5 6 7
16. The doctors of the hospital are always polite. 1 2 3 4 5 6 7 17. The doctors get adequate support from the
hospital to do their jobs well 1 2 3 4 5 6 7
xxii
18. The hospital did not give individual attention to patients
1 2 3 4 5 6 7
19. Doctors of the hospital did not give personal attention to patients
1 2 3 4 5 6 7
20. Doctors of the hospital do not know what patients needs are
1 2 3 4 5 6 7
21. The hospital did not have patients interests at heart
1 2 3 4 5 6 7
22. The hospital did not have operating hours convenient to all their patients
1 2 3 4 5 6 7
I sincerely thank you for spending your valuable ti me and kindly return
the filled-in form to the investigator
xxiii
4. QUESTIONNAIRE – FOR NURSES This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.
This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually
appealing. 1 2 3 4 5 6 7
3. The nurses are well dressed and appear neat. 1 2 3 4 5 6 7 4. The appearance of the physical facilities of the
hospital is excellent, keeping in view of the type of services required.
1 2 3 4 5 6 7
5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.
1 2 3 4 5 6 7
6. When patients have problems, the nurses were sympathetic and reassuring.
1 2 3 4 5 6 7
7. The hospital is dependable 1 2 3 4 5 6 7 8. You have provided services at the time you
promised to do so 1 2 3 4 5 6 7
9. You have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when
services will be performed 1 2 3 4 5 6 7
11. Your patients did not receive prompt service from the nurses
1 2 3 4 5 6 7
12. Nurses of the hospital not always willing to help patients
1 2 3 4 5 6 7
13. Nurses of the hospital are too busy to respond to patient request promptly
1 2 3 4 5 6 7
14. Patients can trust the nurses of the hospital. 1 2 3 4 5 6 7 15. Patients feel safe in their transactions with the
nurses. 1 2 3 4 5 6 7
16. The nurses of the hospital are always polite. 1 2 3 4 5 6 7 17. The nurses get adequate support from the
hospital to do their jobs well 1 2 3 4 5 6 7
xxiv
18. The hospital did not give individual attention to patients
1 2 3 4 5 6 7
19. Nurses of the hospital did not give personal attention to patients
1 2 3 4 5 6 7
20. Nurses of the hospital do not know what patients needs are
1 2 3 4 5 6 7
21. The hospital did not have patients interests at heart
1 2 3 4 5 6 7
22. The hospital did not have operating hours convenient to all their patients
1 2 3 4 5 6 7
I sincerely thank you for spending your valuable ti me and kindly return the filled-in form to the investigator who handed over this to you.
xxv
5. QUESTIONNAIRE – FOR PARAMEDICAL STAFF This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.
This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually
appealing. 1 2 3 4 5 6 7
3. The Paramedical Staff are well dressed and appear neat.
1 2 3 4 5 6 7
4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required.
1 2 3 4 5 6 7
5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.
1 2 3 4 5 6 7
6. When patients have problems, the Paramedical Staff were sympathetic and reassuring.
1 2 3 4 5 6 7
7. The hospital is dependable 1 2 3 4 5 6 7 8. You have provided services at the time you
promised to do so 1 2 3 4 5 6 7
9. You have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when
services will be performed 1 2 3 4 5 6 7
11. Your patients did not receive prompt service from the Paramedical Staff
1 2 3 4 5 6 7
12. Paramedical Staff of the hospital not always willing to help patients
1 2 3 4 5 6 7
13. Paramedical Staff of the hospital are too busy to respond to patient request promptly
1 2 3 4 5 6 7
14. Patients can trust the nurses of the hospital. 1 2 3 4 5 6 7 15. Patients feel safe in their transactions with the
Paramedical Staff. 1 2 3 4 5 6 7
16. The Paramedical Staff of the hospital are always polite.
1 2 3 4 5 6 7
17. The Paramedical Staff get adequate support from 1 2 3 4 5 6 7
xxvi
the hospital to do their jobs well 18. The hospital did not give individual attention to
patients 1 2 3 4 5 6 7
19. Paramedical Staff of the hospital did not give personal attention to patients
1 2 3 4 5 6 7
20. Paramedical Staff of the hospital do not know what patients needs are
1 2 3 4 5 6 7
21. The hospital did not have patients interests at heart
1 2 3 4 5 6 7
22. The hospital did not have operating hours convenient to all their patients
1 2 3 4 5 6 7
I sincerely thank you for spending your valuable ti me and kindly return the filled-in form to the investigator who handed over this to you.
xxvii
6. QUESTIONNAIRE – FOR SUPPORT SERVICE STAFF This survey is to successfully complete my doctoral research in management education related to hospitals in Hydera bad and their service quality. It is extremely critical having t he below information and your help is greatly appreciated. We assure the con fidentiality by keeping your identity unrevealed.
This survey deals with your opinions of health services. Please show the extent to which you think firms offering health services should possess the features described by each statement. Do this by picking one of the seven numbers next to each statement. If you strongly agree that these firms should possess a feature, circle the number 7. If you strongly disagree that these firms should possess a feature, circle 1. If your feelings are not strong, circle one of the numbers in the middle. There is no right or wrong answer – all we are interested in is a number that best shows your expectations about firms offering health services. 1. The hospital has upto date equipment. 1 2 3 4 5 6 7 2. The hospital physical facilities are visually
appealing. 1 2 3 4 5 6 7
3. The Support Staff are well dressed and appear neat.
1 2 3 4 5 6 7
4. The appearance of the physical facilities of the hospital is excellent, keeping in view of the type of services required.
1 2 3 4 5 6 7
5. When the hospital promises to do a treatment (operation/diagnosis etc) by a certain time, it did so.
1 2 3 4 5 6 7
6. When patients have problems, the Support Staff were sympathetic and reassuring.
1 2 3 4 5 6 7
7. The hospital is dependable 1 2 3 4 5 6 7 8. You have provided services at the time you
promised to do so 1 2 3 4 5 6 7
9. You have maintained all the records accurately. 1 2 3 4 5 6 7 10. The hospital did not tell patients exactly when
services will be performed 1 2 3 4 5 6 7
11. Your patients did not receive prompt service from the Support Staff
1 2 3 4 5 6 7
12. Support Staff of the hospital not always willing to help patients
1 2 3 4 5 6 7
13. Support Staff of the hospital are too busy to respond to patient request promptly
1 2 3 4 5 6 7
14. Patients can trust the nurses of the hospital. 1 2 3 4 5 6 7 15. Patients feel safe in their transactions with the
Support Staff. 1 2 3 4 5 6 7
16. The Support Staff of the hospital are always polite. 1 2 3 4 5 6 7 17. The Support Staff get adequate support from the
hospital to do their jobs well 1 2 3 4 5 6 7
xxviii
18. The hospital did not give individual attention to patients
1 2 3 4 5 6 7
19. Support Staff of the hospital did not give personal attention to patients
1 2 3 4 5 6 7
20. Support Staff of the hospital do not know what patients needs are
1 2 3 4 5 6 7
21. The hospital did not have patients interests at heart
1 2 3 4 5 6 7
22. The hospital did not have operating hours convenient to all their patients
1 2 3 4 5 6 7
I sincerely thank you for spending your valuable ti me and kindly return the filled-in form to the investigator who handed over this to you.
xxix
APPENDIX – III
LIST OF TABLES
Table no. Title Page no.
CHAPTER 1
1.1 Key Indicators 6
1.2 Establishment of Primary Health Centers, sub centers and Community Health Centers in India – As per different Five Year Plans
9
1.3 Percentage of Private Hospitals with different bed sizes 10
1.4 Classification of Hospitals 20
1.5 Types of Ailment Complexities 23
1.6 Total Number of Hospitals in India, 2007 27
1.7 Health care Accreditation in various countries 41
1.8 Goals specified in the National Health Policy 2002 46
1.9 Chronology of Service Quality Research 53
CHAPTER 2
2.1 List of some prominent hospitals in Hyderabad 83
2.2 Sample selection of hospitals 85
2.3 Sample Selection of Respondents – Staff 86
2.4 Sample Selection of Respondents – Patients 86
2.5 Variables / Parameters / Characteristics identified 88
CHAPTER 3
3.1 Definition of Original Ten SERVQUAL Dimensions 122
3.2 Definition of Modified SERVQUAL Dimensions 124
3.3 Comparative Analysis of Quality Implementation Issues in the Selected Hospitals
146
3.4 Comparative Analysis of Product Information in the Selected Hospitals
152
3.5 Comparative Analysis of Pricing Information in the Selected Hospitals
155
3.6 Comparative Analysis of Promotion Information in the Selected Hospitals
158
3.7 Comparative Analysis of Placing Information in the Selected Hospitals
159
xxx
3.8 Comparative Analysis of People Information in the Selected Hospitals
161
3.9 Comparative Analysis of Process Information in the Selected Hospitals
164
3.10 Comparative Analysis of Physical Evidence Information in the Selected Hospitals
166
CHAPTER 4
4.1 Perceptions of Administrative Staff on “Tangibles” Dimension
180
4.2 Perception of Doctors on “Tangibles” Dimension 181
4.3 Perception of Nurses on “Tangibles” Dimension 182
4.4 Perception of Paramedical Staff on “Tangibles” Dimension 183
4.5 Perception of Support Staff on “Tangibles” Dimension 185
4.6 Perceptions of Administrative Staff on “Reliability” Dimension
188
4.7 Perception of Doctors on “Reliability” Dimension 189
4.8 Perception of Nurses on “Reliability” Dimension 190
4.9 Perception of Paramedical Staff on “Reliability” Dimension 192
4.10 Perception of Support Staff on “Reliability” Dimension 193
4.11 Perceptions of Administrative Staff on “Responsiveness” Dimension
196
4.12 Perception of Doctors on “Responsiveness” Dimension 198
4.13 Perception of Nurses on “Responsiveness” Dimension 199
4.14 Perception of Paramedical Staff on “Responsiveness” Dimension
200
4.15 Perception of Support Staff on “Responsiveness” Dimension
202
4.16 Perceptions of Administrative Staff on “Assurance” Dimension
205
4.17 Perception of Doctors on “Assurance” Dimension 206
4.18 Perception of Nurses on “Assurance” Dimension 208
4.19 Perception of Paramedical Staff on “Assurance” Dimension
209
4.20 Perception of Support Staff on “Assurance” Dimension 210
4.21 Perceptions of Administrative Staff on “Empathy” Dimension
214
4.22 Perception of Doctors on “Empathy” Dimension 215
4.23 Perception of Nurses on “Empathy” Dimension 217
4.24 Perception of Paramedical Staff on “Empathy” Dimension 219
xxxi
4.25 Perception of Support Staff on “Empathy” Dimension 220
4.26 Two Way ANOVA test between Hospitals and Tangibles (Administrative Staff)
223
4.27 Two Way ANOVA test between Hospitals and Tangibles (Doctors)
225
4.28 Two Way ANOVA test between Hospitals and Tangibles (Nurses)
226
4.29 Two Way ANOVA test between Hospitals and Tangibles (Paramedical Staff)
227
4.30 Two Way ANOVA test between Hospitals and Tangibles (Support Staff)
228
4.31 Two Way ANOVA test between Hospitals and Reliability (Administrative Staff)
229
4.32 Two Way ANOVA test between Hospitals and Reliability (Doctors)
230
4.33 Two Way ANOVA test between Hospitals and Reliability (Nurses)
231
4.34 Two Way ANOVA test between Hospitals and Reliability (Paramedical Staff)
233
4.35 Two Way ANOVA test between Hospitals and Reliability (Support Staff)
234
4.36 Two Way ANOVA test between Hospitals and Responsiveness (Administrative Staff)
235
4.37 Two Way ANOVA test between Hospitals and Responsiveness (Doctors)
236
4.38 Two Way ANOVA test between Hospitals and Responsiveness (Nurses)
237
4.39 Two Way ANOVA test between Hospitals and Responsiveness (Paramedical Staff)
238
4.40 Two Way ANOVA test between Hospitals and Responsiveness (Support Staff)
239
4.41 Two Way ANOVA test between Hospitals and Assurance (Administrative Staff)
240
4.42 Two Way ANOVA test between Hospitals and Assurance (Doctors)
242
4.43 Two Way ANOVA test between Hospitals and Assurance (Nurses)
243
4.44 Two Way ANOVA test between Hospitals and Assurance (Paramedical Staff)
244
4.45 Two Way ANOVA test between Hospitals and Assurance (Support Staff)
245
4.46 Two Way ANOVA test between Hospitals and Empathy (Administrative Staff)
246
4.47 Two Way ANOVA test between Hospitals and Empathy (Doctors)
247
4.48 Two Way ANOVA test between Hospitals and Empathy (Nurses)
249
xxxii
4.49 Two Way ANOVA test between Hospitals and Empathy (Paramedical Staff)
250
4.50 Two Way ANOVA test between Hospitals and Empathy (Support Staff)
251
CHAPTER 5
5.1 Summary of hospital service quality dimensions 261 5.2
Gender distribution of Patients 265
5.3 Age distribution of Patients 266 5.4
Income Distribution of Patients 267
5.5 Residence distribution of Patients
268
5.6 Education distribution of Patients
269
5.7 “No. of visits distribution” of Patients
270
5.8 “Category of treatment” distribution of Patients
272
5.9 Case Processing Summary of Hospital * Gender Cross Tabulation
273
5.10 Case Processing Summary of Gender * Hospital Cross Tabulation
274
5.11 Chi-Square values of Hospital * Gender Cross Tabulation 275 5.12 Chi-Square values of Gender * Hospital Cross Tabulation 275 5.13 Case Processing Summary of Hospital * Age Cross
Tabulation 276
5.14 Chi-Square values of Hospital * Age Cross Tabulation 277 5.15 Case Processing Summary of Hospital * Income Cross
Tabulation 278
5.16 Chi-Square values of Hospital * Income Cross Tabulation 279 5.17 Case Processing Summary of Hospital * Residence Cross
Tabulation 280
5.18 Case Processing Summary of Residence * Hospital Cross Tabulation
280
5.19 Chi-Square values of Hospital * Residence Cross Tabulation
281
5.20 Chi-Square values of Residence * Hospital Cross Tabulation
282
5.21 Case Processing Summary of Hospital * Education Cross Tabulation
282
5.22 Chi-Square values of Hospital * Education Cross Tabulation
283
5.23 Case Processing Summary of Hospital * Number of Visits Cross Tabulation
284
5.24 Chi-Square values of Hospital * Education Cross Tabulation
285
xxxiii
5.25 Case Processing Summary of Hospital * Category of Treatment Cross Tabulation
286
5.26 Chi-Square values of Hospital * Category of Treatment Cross Tabulation
287
5.27 Two Way ANOVA test between Hospitals and Tangibles 288 5.28 Two Way ANOVA test between Hospitals and Reliability 289 5.29 Two Way ANOVA test between Hospitals and
Responsiveness 290
5.30 Two Way ANOVA test between Hospitals and Assurance 291 5.31 Two Way ANOVA test between Hospitals and Empathy 292 5.32 Description of Service Quality Gaps 297 5.33 Gap Scores of Apollo Hospital – Tangibles 298 5.34 Gap Scores of Care Hospital – Tangibles 300 5.35 Gap Scores of NIMS – Tangibles 301 5.36 Gap Scores of Gandhi Hospital – Tangibles 303 5.37 Gap Scores of OGH – Tangibles 304 5.38 Average Overall Scores – Tangibles 306 5.39 Gap Scores of Apollo Hospital – Reliability 307 5.40 Gap Scores of Care Hospital – Reliability 308 5.41 Gap Scores of NIMS – Reliability 310 5.42 Gap Scores of Gandhi Hospital – Reliability 311 5.43 Gap Scores of OGH – Reliability 313 5.44 Average Overall Scores – Reliability 314 5.45 Gap Scores of Apollo Hospital – Responsiveness 315 5.46 Gap Scores of Care Hospital – Responsiveness 317 5.47 Gap Scores of NIMS – Responsiveness 319 5.48 Gap Scores of Gandhi Hospital – Responsiveness 321 5.49 Gap Scores of OGH – Responsiveness 323 5.50 Average Overall Scores – Responsiveness 325 5.51 Gap Scores of Apollo Hospital – Assurance 327 5.52 Gap Scores of Care Hospital – Assurance 328 5.53 Gap Scores of NIMS – Assurance 330 5.54 Gap Scores of Gandhi Hospital – Assurance 331 5.55 Gap Scores of OGH – Assurance 333 5.56 Average Overall Scores – Assurance 334 5.57 Gap Scores of Apollo Hospital – Empathy 336 5.58 Gap Scores of Care Hospital – Empathy 338 5.59 Gap Scores of NIMS – Empathy 340 5.60 Gap Scores of Gandhi Hospital – Empathy 341 5.61 Gap Scores of OGH – Empathy 343 5.62 Average Overall Scores – Empathy 345 5.63 Average Scores on Expectations, Perceptions and
Difference between Expectation and Perception: Gap-5 347
5.64 Aggregated dimensional scores and overall Service Quality Index (SQI): Gap 5
350
5.65 Average scores of average dimensions 351 5.66 SERVQUAL Scores by Dimensions and by Hospitals 353
xxxiv
LIST OF CHARTS
Chart No. Title Page No.
CHAPTER 1
1.1 Number of hospitals and number of beds 9 1.2 Comparative expenditures between public and private
sectors in India 11
1.3 Health Expenditure as per cent of GDP 2003 16
CHAPTER 4
4.1 Perceptions of Administrative Staff on “Tangibles” Dimension
180
4.2 Perception of Doctors on “Tangibles” Dimension 181
4.3 Perception of Nurses on “Tangibles” Dimension 182
4.4 Perception of Paramedical Staff on “Tangibles” Dimension 184
4.5 Perception of Support Staff on “Tangibles” Dimension 185
4.6 Staff Perception on “Tangibles” Dimension 187
4.7 Perceptions of Administrative Staff on “Reliability” Dimension
188
4.8 Perception of Doctors on “Reliability” Dimension 189
4.9 Perception of Nurses on “Reliability” Dimension 191
4.10 Perception of Paramedical Staff on “Reliability” Dimension 192
4.11 Perception of Support Staff on “Reliability” Dimension 193
4.12 Staff Perception on “Reliability” Dimension 195
4.13 Perceptions of Administrative Staff on “Responsiveness” Dimension
197
4.14 Perception of Doctors on “Responsiveness” Dimension 198
4.15 Perception of Nurses on “Responsiveness” Dimension 199
4.16 Perception of Paramedical Staff on “Responsiveness” Dimension
201
4.17 Perception of Support Staff on “Responsiveness” Dimension
202
4.18 Staff Perception on “Responsiveness” Dimension 204
4.19 Perceptions of Administrative Staff on “Assurance” Dimension
205
4.20 Perception of Doctors on “Assurance” Dimension 207
4.21 Perception of Nurses on “Assurance” Dimension 208
xxxv
4.22 Perception of Paramedical Staff on “Assurance” Dimension
209
4.23 Perception of Support Staff on “Assurance” Dimension 211
4.24 Staff Perception on “Assurance” Dimension 213
4.25 Perceptions of Administrative Staff on “Empathy” Dimension
214
4.26 Perception of Doctors on “Empathy” Dimension 216
4.27 Perception of Nurses on “Empathy” Dimension 217
4.28 Perception of Paramedical Staff on “Empathy” Dimension 219
4.29 Perception of Support Staff on “Empathy” Dimension 220
4.30 Staff Perception on “Empathy” Dimension 222
CHAPTER 5
5.1 Gender Distribution of Patients
265
5.2 Age distribution of Patients
266
5.3 Income Distribution of Patients
267
5.4 Residence Distribution of Patients
268
5.5 Education Distribution of Patients
269
5.6 “Number of Visits” Distribution of Patients
271
5.7 “Category of Treatment” Distribution of Patients
272
5.8 Gap Scores of Apollo Hospital – Tangibles 299 5.9 Gap Scores of Care Hospital – Tangibles 301 5.10 Gap Scores of NIMS – Tangibles 302 5.11 Gap Scores of Gandhi Hospital – Tangibles 304 5.12 Gap Scores of OGH – Tangibles 305 5.13
Average Overall Scores – Tangibles 306
5.14 Gap Scores of Apollo Hospital – Reliability 308 5.15 Gap Scores of Care Hospital – Reliability 309 5.16 Gap Scores of NIMS – Reliability 311 5.17 Gap Scores of Gandhi Hospital – Reliability 312 5.18 Gap Scores of OGH – Reliability 314 5.19
Average Overall Scores – Reliability 315
5.20 Gap Scores of Apollo Hospital – Responsiveness 317 5.21 Gap Scores of Care Hospital – Responsiveness 319 5.22 Gap Scores of NIMS – Responsiveness 321 5.23 Gap Scores of Gandhi Hospital – Responsiveness 323
xxxvi
5.24 Gap Scores of OGH – Responsiveness 325 5.25
Average Overall Scores – Responsiveness 326
5.26 Gap Scores of Apollo Hospital – Assurance 328 5.27 Gap Scores of Care Hospital – Assurance 329 5.28 Gap Scores of NIMS – Assurance 331 5.29 Gap Scores of Gandhi Hospital – Assurance 332 5.30 Gap Scores of OGH – Assurance 334 5.31
Average Overall Scores – Assurance 335
5.32 Gap Scores of Apollo Hospital – Empathy 337 5.33 Gap Scores of Care Hospital – Empathy 339 5.34 Gap Scores of NIMS – Empathy 341 5.35 Gap Scores of Gandhi Hospital – Empathy 343 5.36 Gap Scores of OGH – Empathy 345 5.37
Average Overall Scores – Empathy 346
5.38 Overall Service Quality Index 350 5.39 Average scores of average dimensions 352 5.40 SERVQUAL Scores by Dimensions and by Hospitals 353
LIST OF FIGURES
Figure No. Title Page No.
CHAPTER 1
1.1 Flow of relationship within Health Sector operators 32
CHAPTER 3
3.1 Correlation between Modified SERVQUAL Dimensions and Original Ten
125
3.2 Service Quality Gap Model by Zeithaml et al. 130
3.3 Key Factors Contributing to Gap 1 132
3.4 Key Factors Contributing to Gap 2 132
3.5 Key Factors Contributing to Gap 3 133
3.6 Key Factors Contributing to Gap 4 134
CHAPTER 5
5.1 The Gap Model (Reproduced from Parasuraman, Zeithaml and Berry, 1985)
295
5.2 Extension of the Gap Model 296